[Neonatal and child tetanus morbidity and mortality in the University hospitals of Abidjan, Côte d'Ivoire (2001-2010)]. / Morbidité et mortalité du tétanos des nouveau-nés et des enfants dans les Centres hospitaliers universitaires d'Abidjan, Côte d'Ivoire (2001-2010).

The lack of data on neonatal tetanus and children in university hospitals (UH) in Abidjan for over a decade has motivated the realization of this study. The objective of this study is to evaluate the morbidity and mortality related to neonatal tetanus (NT) and child tetanus (CT) in Abidjan University Hospital from 2001 to 2010. It is a retrospective study, multicenter analysis with records of newborns and children suffering from tetanus in the three UH of Abidjan. The collection and analysis of data were made by the SPHINX 4.5 and EPI.INFO 6.0 software. In ten years, 242 cases of tetanus (53 NT cases and 189 CT cases) were collected with a predominance of cases after the fifth year of life (59.5%). The incidence rate of NT was less than 1 case per 1,000 live births. All mothers of the newborns were inhabiting the city of Abidjan. Their median age was 19 years [16-32] and 64% were teenagers. Gateways were dominated by umbilical wounds (77.3%) in the NTand skin wounds (59%) in CT. The cure rate was 30.2% in the NT and 60% in the CT. Lethality was 60% for NT and 22% for CT with a positive correlation with young age (neonates: p = 4.10-7, age <5 years: p = 0.01), lack of intraspinal injection of tetanus serum (p = 8.10-6), the absence of conventional antibiotic therapy (p = 0.023), the existence of metabolic complications (p = 2.10-5), the score of ≥ 4 Dakar (p = 0.005). Tetanus remains a real morbidly cause among children in Abidjan University Hospital with high lethality. However, the incidence of NT seems consistent with the incidence threshold desired by WHO.

[Tetanus in women of childbearing age at the infectious diseases clinic in Dakar]. / Le tétanos de la femme en age de procréer a la clinique des maladies infectieuses de Dakar.

The objective of this article was to describe the epidemiological and outcome features of tetanus in the woman of childbearing age (WCBAT) and compare them with neonatal tetanus (NT) and other tetanus cases in a hospital department in Dakar from 1998 to 2007. A retrospective study was conducted using the files of WCBAT (15 to 49 years old), NT (3 to 28 days old) and other tetanus cases admitted at the Infectious Diseases Clinic, in Fann University Hospital, from 1998 to 2007. 1484 cases of tetanus were admitted in 10 years, with 176 cases of tetanus of WCBAT (11.8%) and 178 cases of NT (11.9%). In comparison with WCBAT the NT annual hospital rate significantly decreased during the study period whereas other tetanus cases rate remained stable. The average age of WCBAT was 26.1 year old and 57.9% were between 15 and 25 years old. The geographical origin was identical for all patients, with more than 71% coming from suburban areas. Most of the WCBAT cases were housewives (50.9%), single women (75%) without updated tetanus immunization (92%). The main portals of entry of WCBAT were injuries and wounds (67.4%) and maternal tetanus cases were rare (8%), mainly post-abortum. At admission, WCBAT cases were less severe than NT cases but more severe than other tetanus cases. The lethality rate of WCBAT cases (28.4%) was significantly lower than NT cases (50%, p = 0.00003), but higher than the other tetanus cases (22.2%; NS). Prognostic factors were: non-identified or intramuscular injection portal of entry and a Mollaret state III at admission. An intensification of the extended immunization program associated with supplementary immunization campaigns targeting women of child bearing age in high risk districts, are necessary to eradicate neonatal and maternal tetanus in Dakar.

Tetanus

It presents information, documents, publications, fact sheets, news and events on tetanus.

Effects of extra immunization efforts on routine immunization at district level in Pakistan.

A study was made of the effects of extra immunization activities on routine immunization coverage at district level in Pakistan in a secondary analysis of data from UNICEF and the Pakistan national census. Linear regression analysis was made on data from 107 districts to estimate the effects of extra immunization efforts in the national neonatal tetanus programme on the coverage rate of the third dose of diphtheria-pertussis-tetanus (DPT3) after controlling for other potential confounding factors. The districts that implemented extra national neonatal tetanus immunization were at risk of having lower routine DPT3 coverage than those that did not. Additional immunization efforts, without additional resources, may reduce the effect of the routine Expanded Programme on Immunization.

Candidate bacterial conditions.

This article provides background information on bacterial diseases and discusses those that are candidates for elimination or eradication. Only one disease, neonatal tetanus, is a strong candidate for elimination. Others, including Haemophilus influenzae b infection, leprosy, diphtheria, pertussis, tuberculosis, meningococcal disease, congenital syphilis, trachoma and syphilis are important causes of morbidity and mortality in industrialized and developing countries. For all these diseases, eradication/elimination is not likely because of the characteristics of the disease and limitations in the interventions.

Sensitivity of neonatal tetanus surveillance system in India.

OBJECTIVE: To estimate the sensitivity of neonatal tetanus (NNT) surveillance in India. DESIGN: A comparison of two sets of data obtained from NNT mortality surveys and routine surveillance system. METHODS: NNT mortality surveys were undertaken in 1981, 1989 and 1992 using 30 cluster sampling technique. The data on reported incidence of NNT through routine surveillance system was taken from the published documents of Health Ministry and WHO. RESULTS: In 1981, the incidence of disease in a national survey was estimated to be 4 and 16.4 per 1000 live births in urban and rural areas, respectively. Follow up surveys in 1989 and 1992 estimated the overall incidence as 4 and 1.74 per 1000 live births, respectively. Comparing the reported and estimated by surveys, around 10% of NNT cases were reported. CONCLUSIONS: There is an urgent need to strengthen the routine surveillance system which at present grossly under-reports the NNT incidence in India.

A new prognostic scoring system in neonatal tetanus.

A prospective study of 75 cases of neonatal tetanus was carried out with a view to developing a prognostic scoring system which can be used to assess the severity of the disease and to serve as a basis for comparing results of different therapeutic interventions from various centres. The case fatality rate was 77.3%. A table was designed containing 6 parameters and a rating of 1 to 4 was given to each parameter in decreasing order of severity. The minimum total score attainable was 6 and the maximum 24 (the severity of the disease was inversely proportional to the score). The differences between the means of each of the parameters among patients who died and the survivors were significant (P < 0.005). Regression analysis showed that each of the parameters independently had a significant effect on the total score (P < 0.005). Using the percentage mortality at each score, a pattern emerged such that total scores of 6-11 indicated severe tetanus (mortality rate 100%); 12-17, moderate disease (mortality rate 68%), and total scores of > 17 indicated mild neonatal tetanus (mortality rate 18%). Associated poor prognostic factors identified included pneumonia, recurrent apnoea, cyanosis, and opisthotonus.

Neonatal tetanus in Port Harcourt.

In a previous study on neonatal tetanus (NNT), we provided information on clinico-epidemiological data and reported a case-fatality rate of 60.3%. The present report covers a 7-year period, January 1984 to December 1990, and amongst others, focuses on tetanus toxoid vaccine (TT) coverage of pregnant women. The subjects were those with a diagnosis of NNT and other neonatal admissions. Total neonatal admissions, NNT admissions, neonatal deaths, and NNT deaths were: 4,315, 471, 727, and 221 respectively. The overall NNT case-fatality rate was 46.9%. The highest NNT admission rate was in the third quarter of 1984, with a significant decline subsequently except for the increase in 1989. The neonatal tetanus rate began dropping appreciably from 1988 although less than 10% of the mothers in 1990 received two doses of TT. The improper immunization of the mothers during pregnancy with TT is worrying particularly several years into the Expanded Programme on Immunization (EPI), more so as the experience is not unique to Port Harcourt. We suggest intervention at the community level, operational research, and ethnographic studies to determine possible underlying factors to be carried out in all health zones of the country.

Cross cultural communication of tetanus vaccinations in Bolivia.

Although neonatal tetanus (NNT) is common in developing countries, many people are unaware of its causes and prevention. A study analyzed cultural beliefs and practices to understand how people in three cultural areas in Bolivia (Aymara, Quechua and Tupi-Guarani) think about NNT and tetanus toxoid (TT) immunizations. In all three cultural areas NNT is perceived within a magical and biological framework that involves alternative healing systems and healers. Tetanus immunization programs could be more successful if tetanus were a clearly marked target for the Aymara, Quechua and Tupi-Guarani people, and vaccinators were sensitive to their cultural perceptions. Health workers need to communicate cross-culturally the relationship of TT vaccinations to how members of these ethnic groups perceive NNT.